流式细胞术免疫分型技术检测骨髓中髓系原始细胞比例及淋巴细胞比例可有效鉴别再生障碍性贫血及低增生性骨髓增生异常综合征  

Detection of the proportion of myeloid progenitor cells and lymphocytes in bone marrow by flow cytometry immunophenotyping can effectively identify aplastic anemia and hypoplastic myelodysplastic syndrome

作　　者：李丽 王子娥 王倩 孙慧 王晶 张之芬 张健 Li Li;Wang Zie;Wang Qian;Sun Hui;Wang Jing;Zhang Zhifen;Zhang Jian(Department of Clinical Laboratory,Shandong Provicial Hospital Affiliated to Shandong First Medical Uniersity,Jinan 250000,China)

机构地区：[1]山东第一医科大学附属省立医院临床医学检验部,济南250000

出　　处：《中华检验医学杂志》2023年第9期911-918,共8页Chinese Journal of Laboratory Medicine

基　　金：山东省自然科学基金(ZR2020MH310)。

摘　　要：目的分析再生障碍性贫血(AA)与低增生性骨髓增生异常综合征(低增生MDS)骨髓流式细胞学特点,寻找有效鉴别AA与低增生MDS的诊断指标。方法回顾性研究2017年1月至2021年12月在山东第一医科大学附属省立医院就诊的618例外周血象异常的患者,其中441例经临床诊疗证实未患有AA、低增生MDS及其他血液系统肿瘤的患者作为对照组,AA患者57例,低增生MDS患者52例,骨髓穿刺稀释患者68例。使用流式细胞术免疫分型技术分析各组患者骨髓中髓系原始细胞、淋巴细胞、中性粒细胞及有核红细胞比例,采用Kruskal-Wallis单因素方差分析比较AA及低增生MDS患者骨髓髓系原始细胞、淋巴细胞、中性粒细胞及有核红细胞比例的差异,使用受试者工作特征(ROC)曲线评价各参数鉴别AA及低增生MDS的诊断效能。结果对照组患者骨髓髓系原始细胞比例为[0.30%(0.20%,0.46%)],AA患者骨髓髓系原始细胞比例为[0(0,0.04%)],而低增生MDS患者骨髓髓系原始细胞比例为[3.10%(1.25%,6.71%)],AA患者骨髓髓系原始细胞比例低于对照组患者(χ^(2)=302.90,P<0.001),而低增生MDS患者骨髓髓系原始细胞比例高于对照组患者(χ^(2)=203.88,P<0.001)。骨髓髓系原始细胞比例鉴别AA与低增生MDS的ROC曲线下面积为0.996,当选取临界值为0.21%时,其敏感度为96.2%,特异度为100%。对照组患者骨髓淋巴细胞比例为[10.39(7.33,14.80)]%,AA患者骨髓淋巴细胞比例为[52.67%(42.20%,67.68%)],低增生MDS患者骨髓淋巴细胞比例为[24.68%(15.51%,35.19%)],AA患者与低增生MDS患者骨髓淋巴细胞比例均高于对照组患者(χ^(2)=298.74,P<0.001;χ^(2)=194.33,P<0.001),且AA组患者骨髓淋巴细胞比例高于低增生MDS组患者,差异具有统计意义(χ^(2)=104.41,P=0.002)。淋巴细胞比例鉴别AA及低增生MDS的ROC曲线下面积为0.882,当临界值为41.6%时,其敏感度为78.9%,特异度为92.3%。结论流式细胞术免疫分型技术检测骨髓中髓Objective To investigate the flow cytometric characteristics of bone marrow in patients with aplastic anemia(AA)and hypoplastic myelodysplastic syndrome(hypoMDS)and its value in differential diagnosis between AA and hypoMDS.Methods A total of 618 patients were recruited from Shandong Provincial Hospital affiliated to Shandong First Medical University from January 2017 to December 2021,including 441 patients as controls with abnormal peripheral blood counts but confirmed to have no AA,hypoproliferative MDS,or other hematological tumors,57 patients with AA,52 patients with hypoMDS and 68 patients with diluted bone marrow.The proportions of bone marrow myeloid progenitor cell,lymphocyte,neutrophil and erythroid cell in bone marrow were analyzed by flow cytometry immunophenotyping.The differences between the four groups were compared by Kruskal-Wallis one-way ANOVA.The diagnostic efficacy was evaluated by the receiver operating characteristic(ROC)curve.Results The proportion of myeloid progenitor cells in control group was[0.30%(0.20%,0.46%)];the proportion of myeloid progenitor cells in AA group was[0.00(0.00,0.04)]%,while the proportion of myeloid progenitor cells in hypoMDS group was[3.10%(1.25%,6.71%)].The proportion of myeloid progenitor cells in AA group was lower than that in control group(χ^(2)=302.90,P<0.001),while the proportion of myeloid progenitor cells in the bone marrow of patients with hypoMDS was higher than that in the control group(χ^(2)=203.88,P<0.001).The area under the ROC curve for identifying AA and hypoMDS by the ratio of myeloid progenitor cells in bone marrow is 0.996,with the sensitivity of 96.2%and the specificity of 100%when the cutoff value is 0.21%.The proportion of bone marrow lymphocytes in control group was[10.39%(7.33%,14.80%)];the proportion of bone marrow lymphocytes in AA group was[52.67%(42.20%,67.68%)],and the proportion of bone marrow lymphocytes in hypoMDS group was[24.68%(15.51%,35.19%)].The proportion of bone marrow lymphocytes in AA group or hypoMDS group was higher tha

关 键 词：原始细胞 淋巴细胞 再生障碍性贫血 低增生性骨髓增生异常综合征 骨髓 流式细胞术 

分 类 号：R551.3[医药卫生—血液循环系统疾病] R556.5[医药卫生—内科学]